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Pulmonary vasodilator use in very preterm infants in United States children's hospitals
Nicolas Bamat1, Tomas Vega1, Matthew Huber
1The Children's Hospital of Philadelphia.
Insights
Pulmonary vasodilators (PV) like inhaled nitric oxide (iNO) and sildenafil are used in very preterm infants. Early PV use is linked to lower gestational age and small for gestational age, while late use is associated with bronchopulmonary dysplasia.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Pharmacology
Background:
- Pulmonary vasodilators (PV) are critical in managing respiratory conditions in neonates.
- Understanding the patterns of PV use in very preterm (VP) infants is essential for optimizing care.
- Limited data exists on the timing and patient characteristics associated with PV administration in VP infants.
Purpose of the Study:
- To characterize the common pulmonary vasodilators (PV) used in very preterm (VP) infants.
- To describe the timing of PV exposure during hospitalization.
- To identify patient characteristics associated with PV use in VP infants.
Main Methods:
- An observational study analyzed data from 37,428 very preterm infants discharged from U.S. children's hospitals between 2011 and 2021.
- Pulmonary vasodilator exposures during hospitalization were identified.
- Multivariable modeling was employed to determine characteristics associated with PV exposure.
Main Results:
- 6.3% of VP infants received PV, with early inhaled nitric oxide (iNO) and late sildenafil being most common.
- Early PV exposure was significantly associated with lower gestational age (aOR: 9.2) and being small for gestational age (SGA) (aOR: 2.3).
- Late PV exposure correlated with higher-grade bronchopulmonary dysplasia (BPD) (aOR: 26.2) and prior early PV exposure (aOR: 3.7).
Conclusions:
- Early iNO and late sildenafil are utilized in VP infants, often without robust supporting evidence.
- Evidence gaps exist for studies focusing on extremely preterm or SGA infants for early PV use.
- Further research is needed for late PV use in infants with early PV exposure or high-grade BPD.
Objectives:
To describe common pulmonary vasodilators (PV), exposure timing, and characteristics associated to their use in very preterm (VP) infants.
Study Design:
Observational study of VP infants discharged from U.S. children's hospitals (2011-2021). PV exposures during hospitalization were identified, and multivariable modeling determined characteristics associated with exposure.
Results:
Among 37,428 infants, 6.3% received PV. Early inhaled nitric oxide (iNO) and late sildenafil were most common. Early exposure was associated with lower gestational age, aOR: 9.2 (7.3-11.7), 22-25 vs. 29-31 weeks) and small for gestational age (SGA), 2.3 (2.0-2.7). Late exposure was associated with bronchopulmonary dysplasia (BPD) grade, 26.2 (16.8-40.9), grade 3 vs. no BPD) and early PV exposure, 3.7 (2.9-4.8).
Conclusions:
Early iNO and late sildenafil are used in VP infants despite limited evidence. Prospective early studies enrolling extremely preterm or SGA infants and late studies enrolling infants with early PV exposure or high-grade BPD would target current evidence gaps.
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